Human Papillomavirus Vaccine Coverage Among Females Aged 11 to 17 in Texas Counties

An Application of Multilevel, Small Area Estimation

Jan M. Eberth, Md Monir Hossain, Jasmin A. Tiro, Xingyou Zhang, James B. Holt, Sally W. Vernon

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Local data are often used to plan and evaluate public health interventions and policy. With increasingly fewer public resources to collect sufficient data to support direct estimation of local outcomes, methods for deriving small area estimates are vital. The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among adolescent females in Texas using multilevel small area estimation. Methods: Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (≥1 dose Gardasil) from the 2008 Behavioral Risk Factor Surveillance System. Using the parameter estimates from the final model, we simulated 10,000 data sets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county. Results: County-level coverage estimates ranged from 7% to 29%, compared with the state average of 18% (95% confidence interval [CI], 13.59-21.88). Many Southwestern border and metropolitan counties exhibited high coverage estimates. Low coverage estimates were noted in the Panhandle, Southeastern border region, and Northeast. Significant correlations were observed between HPV vaccination and Hispanic ethnicity, county poverty, and public health region poverty. Conclusion: Harnessing the flexibility of multilevel small area models to estimate HPV vaccine coverage at the county level, we have provided data that may inform the development of health education programs/policies, the provision of health services, and the planning of new research studies. Additionally, we have provided a framework for modeling other health outcomes at the county level using national survey data.

Original languageEnglish (US)
JournalWomen's Health Issues
Volume23
Issue number2
DOIs
StatePublished - Mar 2013

Fingerprint

Papillomavirus Vaccines
Public Health
coverage
Poverty
Vaccination
Logistic Models
Behavioral Risk Factor Surveillance System
Health Planning
public health
Normal Distribution
vaccination
Public Policy
Health Policy
Health Education
Hispanic Americans
Health Services
Confidence Intervals
poverty
border region
female adolescent

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health
  • Maternity and Midwifery
  • Health(social science)

Cite this

Human Papillomavirus Vaccine Coverage Among Females Aged 11 to 17 in Texas Counties : An Application of Multilevel, Small Area Estimation. / Eberth, Jan M.; Hossain, Md Monir; Tiro, Jasmin A.; Zhang, Xingyou; Holt, James B.; Vernon, Sally W.

In: Women's Health Issues, Vol. 23, No. 2, 03.2013.

Research output: Contribution to journalArticle

Eberth, Jan M. ; Hossain, Md Monir ; Tiro, Jasmin A. ; Zhang, Xingyou ; Holt, James B. ; Vernon, Sally W. / Human Papillomavirus Vaccine Coverage Among Females Aged 11 to 17 in Texas Counties : An Application of Multilevel, Small Area Estimation. In: Women's Health Issues. 2013 ; Vol. 23, No. 2.
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abstract = "Background: Local data are often used to plan and evaluate public health interventions and policy. With increasingly fewer public resources to collect sufficient data to support direct estimation of local outcomes, methods for deriving small area estimates are vital. The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among adolescent females in Texas using multilevel small area estimation. Methods: Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (≥1 dose Gardasil) from the 2008 Behavioral Risk Factor Surveillance System. Using the parameter estimates from the final model, we simulated 10,000 data sets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county. Results: County-level coverage estimates ranged from 7{\%} to 29{\%}, compared with the state average of 18{\%} (95{\%} confidence interval [CI], 13.59-21.88). Many Southwestern border and metropolitan counties exhibited high coverage estimates. Low coverage estimates were noted in the Panhandle, Southeastern border region, and Northeast. Significant correlations were observed between HPV vaccination and Hispanic ethnicity, county poverty, and public health region poverty. Conclusion: Harnessing the flexibility of multilevel small area models to estimate HPV vaccine coverage at the county level, we have provided data that may inform the development of health education programs/policies, the provision of health services, and the planning of new research studies. Additionally, we have provided a framework for modeling other health outcomes at the county level using national survey data.",
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